Why do outpatients fail to keep clinic appointments, asks a report in International Journal of Clinical Practice (1998;52:436-7). The answers are disappointingly predictable: they forget the appointment, feel too ill to make it, or never receive details of it in the first place. In a questionnaire study of nearly 1000 patients who missed their outpatient appointments a third of those scheduled to have a review appointment simply forgot and a fifth were too ill to attend. A tenth of them had travel difficulties, and 1% blamed the weather. Their general lack of enthusiasm was also reflected in the 38% response rate in the survey.

Doctors who would like to find a good home for back copies of the British National Formulary should contact Elaine Harden at the Commonwealth Pharmaceutical Association, who is organising an annual collection of recent editions for the developing world. All the books will be distributed to pharmacists and other health professionals in commonwealth countries (tel 0171 820 3399; email eharden@compuserve.com

Good news is rare in adolescent substance misuse, but recent data suggest that the prevalence of misuse may have reached a plateau (Canadian Medical Association Journal 1998;159:451-4). A survey of nearly 4000 Canadian schoolchildren found that most substances, including alcohol, tobacco, …